Provider First Line Business Practice Location Address:
20545 STATE ROUTE 89
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARKLEEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96120-9527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-694-2302
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2021